That's oh-be-GUY-n, not oh-be-GIN, as some (primarily people from Texas) would like to refer to my chosen profession. Although, working in this field can sometimes cause one to develop a penchant for gin...hmmm.

Saturday, January 10, 2009

Really?

It's a new year, it's raining outside, I'm cranky from dieting, and OtherDoc has been out of town for a week. Do I need to provide anymore preface than that? That's right, time to vent!

It's weeks like this that I truly wonder why any sane person would ever consider being in the medical field. Money? Small potatoes compared to other professions. Autonomy? Hardly. Respect? A resounding "Ha! I don't freaking think so!!" I don't know about anyone else, but I am getting sick of hearing about what Op.rah thinks about my profession. This week a patient advised me (and I quote), "Well, Op.rah said to be sure you use the very smallest, um, sepulchre things, and warm it up, too!" Um, did you *really* just say that to me? Really?? Gee, I would have never thought of that without Op.rah's help. Thank you so much for enlightening me, O great one, in how to better practice medicine for my patients. News flash, I know, but I *already* use small *speculums* and I always warm them, too thankyouverymuch. I am already cringing about next week when all the people that watched her s.ex show on Friday call in for urgent, stat libido check appointments. Thanks a heap, O.

It's not just her jumping on the bash physicians bandwagon, though. I see magazine articles and news stories every day instructing people how to "Find out if you have a *good* doctor," or "Things your doctor isn't telling you," or "Medical horror stories, part 374." It makes me physically ill. Like we don't have enough on our proverbial plates, now we have to dispel the media panic surrounding our profession, as well. Why is it that you never see articles about "Accountants gone bad!" or "What your plumber isn't telling you (but should)"? It certainly doesn't help me out when patients come in with printed sheaves of website information instructing me on how to treat their perceived ailment, before I have a chance to take a history, do an exam, or any baseline lab work. It seems that physicians are being reduced to being the "gatekeeper" of health care, instead of the director. "Just shut up and give me what ever test, drug, diagnosis, etc. that I want." What is worse is that we get this from both patients and insurance companies, further restricting our ability to practice our profession the way we are meant to practice. Don't get me wrong, I'm certainly not of the mindset that physicians are omniscient. I practice collaborative medicine, not paternalistic care, but I see the shift even away from collaboration to patient demanded care, and it just isn't right.

This attitude is reflected in the patients each time they call to demand a Di.flucan prescription without coming in for an appointment, over the phone, even if they haven't been seen in the office for 2 years. Or women who delight in paging the physician at 2 in the morning to ask for the list of cold medicines to take in pregnancy because they "lost" the sheet given them in the office, because that's my *job*, you know? It is also rampant in the lay and medical blogospheres. The fear and mistrust of the medical profession is almost painful to read. Sometimes I have to sit on my hands to keep from commenting, lest I perpetuate the "doctors are assholes" perception. Especially in the birthing blogs, where the common thought is that Ob/Gyns are out to fillet every pregnant woman that comes through the door, just because they are evil, scum sucking doctors and not loving, caring midwives. Practicing medicine isn't what it used to be, and I find myself disheartened at the direction our role in medical care is taking. I see my colleagues (and myself) yearning for a job where we can turn off our brains after plugging in our allotted hours of time, instead of taking our work home with us and worrying about people who only see us as drug dispensing/test ordering automatons.

I still have the flashes of what medicine is supposed to be. I'll have a really great pregnancy/delivery with a patient, or I'll do a surgery that improves some one's quality of life, or I'll make a diagnosis that has the potential to alleviate suffering or even save some one's life. It is those few moments that keep me moving forward, doing what I've spent 12 years of my life training to do. Medicine used to be about helping people, but if the changes I see now continue on, medicine will soon be just another "punching the clock" kind of job. If that happens, my friends, then we all lose. Every single one of us.

17 comments:

As a nurse, I see what physicians put up with everyday, and I am in awe. Just as you say, patients who think they know more than you, insurance companies that dictate how you practice medicine. It's crazy. So, my hats off to you. I could never do what you do, and I admire you.

I had a lot more that I wanted to say, but I think I can sum it up best this way:

The fact that you care? That makes you one of the good ones.

I admit it. I'm one of those patients that doesn't trust a new doctor. AT ALL. And that's only because I've been given every reason in the book to stop trusting them by... them. But when I find a doctor who actually cares about ME rather than about shutting me up to move on to the next one? That's when I'm hooked. The doctor (PA, actually) that I have now and the MD that I had where we used to live are incredible women. I can schedule an appointment, come in with my list of questions, show them the research that I've done and ask them what they know about the symptoms and about what I've read. And while I rely heavily on their education, they also know that they have an informed patient that really WANTS to get better.

It's about mutual respect. You seem to have respect for your patients - and I don't think that's something that has been changed on the blog for HIPPA! When doctors actually care about their patients and respect that Susan is different from April rather than Pregnant Mom 1 and Pregnant Mom 2, we get that!

Hmm,very thought provoking. It must be very difficult to walk the line of respecting patients needs/requests/plans, and being questioned. Yes, without a doubt your 12 years of education mean something. Even with my graduate studies, I can't do what you do. However, that doesn't mean your way is the only right way. Sometimes, other people, even patients who research their symptoms, and plan of care *gasp* on the internet have valid ideas. I personally had a rude OB who told me "I don't care what your 'plans' for birth are, my job is to deliver you a healthy baby." She totally discounted the desires I had for my delivery. In addition I was hypotensive, and passed out at work due to extremely low blood pressure. This being my first pregnancy, I was panicked, I called the office and the receptionist put me in to be seen right away. The OB totally dismissed my concern telling me, "You have this little obstruction called a baby, and you just can't do the things you used to do." I wasn't running a marathon. I was sitting on my buttocks, and counting money. I worked at a bank. I left that physician and transferred care at 30 weeks to a midwife. I have never been back to an OB. Now, that's not to say all OB's are evil and that rude, but it is the type of dismissive un-empathetic behavior I hear about from many people. I'm not an Op.rah watcher, but I do tend to question more than many people I know. From a patient perspective, my questions don't mean I don't trust you, they simply mean I need more information and answers. They mean I try to be informed, and be fully engaged in my care. I try not to be argumentative or demanding. Although there was that time with the Ped... but that's another story. :) All I want is to be sure the care I and my family is getting is best for our needs. Sometimes that mean asking you to listen to my ideas, even defending why you are recommending your position. Sometimes it means respecting the impasse between where I am and you are. Sometimes, it means meeting in the middle. More so than I question the care from my doctors, I question the recommendations set forth by the AMA, AAP, CDC, FDA. There are simply too many proven conflicts (not just conspiracy theory nut-job rants) of interest to not question those organizations. I hope I have provided you with some food for thought as well, and you don't think I've hijacked your blog, or am trying to fight with you, because that's not my purpose at all. I'm just trying ti have an open dialog with a blogger whom I enjoy reading.

Oprah also likes Christine Northrop. I've read her and I think she's alright, but she's also a little too alternative for my taste. Actually, if you are a reader of the blogger Orac (Respectful Insolence) he's got some unkind words for her as well.

Speaking of Plumbers gone bad - I am way happier with all (well almost all) my Physicians than I am with the plumber that I spent more than $1,000 with. That is ALOT more than any co-pay I've had and the darn drain is still leaking into the room below.

So have heart -- there are plumber gone bad folks out there!

I'd also tell you about the Accountant that was going to split the proceeds of refunds we got after following his corporate shell moves, but that is a story for another day.

My aunt is a family practitioner and is looking to leave her practice. She no longer enjoys what she does.. and it's so sad because she is a great doctor, but she says that the profession she entered into 25 years ago is completely gone. It's so unfortunate!

Aw, hang in there! I do agree with you though, there do seem to be a lot of "why you should not trust your doctor" articles and shows.If it is any small consolation as an attorney I continually get the my friend's friend said that you should do my divorce like this, etc. Everyone thinks they have a JD and apparently an MD too:)Would love to hear an update on the impending move / job change sometime!-Amy in OH

You address some serious issues. I am a very informed patient who approaches my ob/gyn with respect and trust. I don't have a gazillion questions, but I do have some and I expect thorough, considerate answers. I'm not picky about a cold speculum or cold ultrasound gel, but I dislike a doctor who rushes and gives me dime store answers to serious questions. I DO NOT watch Oprah, nor do I ascribe to the philosophy that ob/gyns are uncaring, scalpel-happy, birth "rushers" and that midwives are noble, caring, angels of birth. I also grew up with a father who was a rare lupus specialist - talk about a depressing, challenging field. He taught me that there are rarely "simple" answers to complex medical problems and that caring for people's bodies sometimes takes a toll on doctors emotions. I do admire the work you do and appreciatae the difficulty of your job. As hard as it is to be patient with unaware patients, your integrity and care for them will usually far outweigh Oprah, the blooshpere world, and the most current medical scare. If they trust you they will listen to you and that's what you want most: patients who come to you for advice and take it. Keep up your good work!

Yes, physicians today are under fire and what it comes down to is that all of the fear-mongering in the press/web, tons of paperwork, cost of malpractice insurance, fear of getting sued, etc. makes it harder for the truly sick patients to get the time and attention that they need. I think it's especially hard for OB/GYNs because pregnant women (and their partners) can be pretty neurotic and demanding - almost like bridezilla - especially during an era where pregnant celebrities don cover stories in celeb mags. I feel for you!

Why, oh why, hasn't Oprah been struck by lightening? I've been an FP for 27 LONG years (delivered babies for the first 7 years) and I have had just about enough. Oprah, "informed" patients waving the latest drivel off the internet/women's magazine of the day, insurance companies, midlevels and just about everybody else with an axe to grind wants my job. Until there's a problem and the stuff hits the fan. Then it's MY responsiblity: all the responsiblity, all the liability, and but with precious little control of the situation. Sure wish I could retire.

Amen. I am SO SICK of the idea that all OBs are evil and midwives are just little bits of heaven sent from above to help everyone have their happy vaginal birth. Especially from people who've encountered like one crappy OB and make this broad assumption. It's nuts.

It is very hard in this American "I want it now therefore I deserve it NOW" culture to be a doc sometimes. Like my patient today who said she needed an ultrasound bc she "hadn't seen her baby in a while." After I took the time to explain what we use U/S for and why we only do them for a medical indication and how I'm happy to auscultate heart tones again to reassure her (how midwifey of me, no?), she narrowed her eyes, stared at me, and said, "Oh, I'll FIND an indication, don't you worry."

Yeah, I forgot, it was her show, and I was just a character she cast in. Agh. So glad I'm 250K in debt from med school...

Sigh. Everything you say is true. In order to keep working as an obgyn in the USA you have to get past all this and focus on the GOOD that you are doing, as you mentioned in your last paragraph. And I will bet that at your new job you will NOT have to deal with questions about Tylenol at 2am. The anger caused by such unnecessary assaults on your sleep can poison your life. As for the birthing blogs...there is no way any of us docs will ever please those ladies no matter what we do. We were doomed the day we decided not to become midwives. Just don't read them. Also, might I suggest that post-ABOG depression could play a part? You finally made it to the top of the mountain...for this??? I promise you that your professional life will improve by this time next year! RuralObGyn

As an L&D nurse in a teaching hospital, I feel for you. I always say that a LITTLE knowledge is a dangerous thing. When it comes from someone who pretends to be the authority on everything it can be very frustrating. Hang in there.

The "Middle of the Night" Mom with her healthy baby would beg to differ. I was on the edge of my seat reading that one. Regardless of the internet and talk-show crud out there and in spite of the restrictions you have, you continue to impact the lives of your patients. Think about how much more you could do if the system improved, which is probably another cause of patient distress and why they come armed and dangerously wielding O-inspired scripts. The whole system is bloated and ridiculous but you have still found that human connection amidst the chaos. I guess that it my point.